The Four Phases of Armageddon Medicine

In the preface to my upcoming book, Armageddon Medicine, I refer to the four phases health care will likely experience at TEOTWAWKI: floundering, fading, forgotten, and future.

Recently someone asked, Are there any signs the process has already begun? Is the health care system already beginning to flounder?

I think I’ll have to answer yes to that for several reasons.

  1. Doctor shortages . . . Just this week I inherited patients from 3 or 4 other physicians who had recently retired, doctors not much older than myself.  They did not communicate their reasons, but based on what’s happening across the country, I’d conclude it’s the large hassle factor: electronic health records, Medicare cuts, high malpractice, higher patient load with less income. Where does it all end? 
  2. Drug shortages . . . Who hasn’t heard about cancer patients unable to finish their round of chemo treatments?  Along with that, too many drugs are manufactured overseas; too few made in the USA. (Of course stores that sell goods from China will sell drugs from overseas as well. How else to keep the prices down?)
  3. Common sense shortages . . . It doesn’t take a genius to see that, in America, we have more expensive technology than we can pay for. For example, dialysis costs about $200,000 per year per patient. No rationing exists, and as Americans age, the need will only increase for hip replacements, organ transplants, cancer treatment, heart surgery, nursing home care . . . the list goes on and on. Perhaps we have passed the tipping point.  
  4. Privacy shortages . . . Is it really necessary for the government to monitor who gets a flu shot, who receives a reminder of their upcoming doctor appointment, what a person’s body mass is, who receives a colonoscopy? Do we need big brother or Uncle Sam looking over our shoulder? 

I’m thinking maybe the frog’s in the pot and just doesn’t know it yet. Your comments?

Uncle Sam - personification of USA, riding a s...

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About Cynthia J. Koelker, MD

CYNTHIA J KOELKER , MD is a board-certified family physician with over twenty years of clinical experience. A member of American Mensa, Dr. Koelker holds degrees in biology, humanities, medicine, and music from M.I.T., Case Western Reserve University School of Medicine, and the University of Akron. She served in the National Health Service Corps to finance her medical education.
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4 Responses to The Four Phases of Armageddon Medicine

  1. Cora says:

    Instead of allowing ever increasing numbers of specialty doctors, we should require that a larger portion of seats in med school should go only to primary care physicians. There are so many people even in U.S. without primary care, so to continue to recruit and educate doctors for other fields is a scandalous waste of resources, and, to the degree with which it is publicly financed, public money. We should start recruiting students as undergraduates to be primary care physicians. Enough of the elitist **.

    [The National Health Service Corps and certain state agencies are doing just this. I spent 3 years in Appalachian Kentucky working in a doctor-shortage area in return for help with medical school costs. – Doc Cindy]

  2. Mike M, APRN says:

    I heartily agree. I practice in a rural clinic in eastern KY and there are only 2 primary care offices in the county – most of the surrounding counties are in similar situation. To decrease costs on November 1st, our Medicaid split from one into 3 providers to save money???? Our local hospital will not accept one of the Medicaid providers. It is one of 2 hospitals within a 20 mile range, the next nearest is 60 miles.

    Shortages of medications are getting worse, some from lack of physical availability and others due to lack of coverage by insurance. The last flu season our 2 local pharmacies had trouble getting Tamiflu. We have had times when we could not get Cyanobalmin (B12). And now with the split-up of Medicaid at least one of the carriers is not paying for many routinely prescribed medications, to include certain diabetic test strips and fibrates, other than generic Fenofibrate.

    There are 3 primary care physicians and approximately 6 midlevel (PA and NP) providers. Many “rotate“ in for a few months and then leave for the city.

    Common sense shortages abound. Insurances will not pay for smoking cessation yet will pay for chronic pulmonary and cardiac disease related to decades of smoking. Medicaid will not pay for a nursing visit for a weekly injection to be done by a nurse, such as an allergy shot, without them being seen by a provider even though orders for the weekly injections have been documented in the patient’s chart.

    EMR is for government surveillance of healthcare. I have yet to talk with any office who has it that’s feels their efficiency has increased or cost of providing healthcare decreased in all cases it is the opposite.

  3. Chris MD says:

    I could not agree more on all 4 points. Here in VA, we labor under a medicaid system that does not cover our costs, and yet is the only part of the patient pool increasing. Most private docs will not take new medicaid, creating an illusion of a doc shortage; we have taken a cut in pay every year of this century, and have to hire ever-increasing numbers of employees to tackle the gov’t-mandated paperwork and compliance issues (meaningful use, anyone?). Add to this the fact that we have been told by every resident who has rotated with us that they would never consider working for us, because we work too hard. I see bad things arising!

  4. prepster411 says:

    Doing medical work in Haiti really opened my eyes when it comes to “Armageddon” medicine.

    All of the things you mention happen there.

    A week after the earthquake I had a patient with a major crush injury and rhabdomyolysis. I can’t tell you what I went through to get IV fluids and a Foley catheter. He needed dialysis, of course, but I think there were just a couple of dialysis machines in Port-Au-Prince to begin with, and they were crushed in the quake.

    He eventually was unconscious, but breathing. No 02 or labs.

    We transported him to a Doctor Without Borders tent that had just flown in 2 dialysis machines. He was very lucky to live. (He was the 2nd patient treated.) He survived the rhabdo, in addition to a 1-hour trip on an old door in the back of a little pick-up truck.

    In Haiti, if you don’t have money or connections, you just suffer or die. It’s really sad to say it that way, but it’s true.

    I don’t know where this is all headed, but In America, we are drunk on expensive health care.

    As much as I dislike the idea of “rationing” we’re headed there anyway. We can’t afford it.

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